3 Reasons CMS Star Ratings Are Misleading

Philip Betbeze, January 12, 2017

While the federal government's star ratings may be a reliable measure of patient experience, that's about all they can be relied upon to provide, says a provider of healthcare quality and outcomes data.

While the star ratings may be a reliable measure of patient experience, that's about all they can be relied upon to provide, says Frank Mazza, MD, chief medical officer of Quantros, a provider of quality and outcomes data to employers choosing healthcare options for their employees.

When the CMS ratings came out, Mazza, an intensive care specialist by training, noticed the lack of five-star rated organizations that offer complex services such as intensive care.

"We, like everyone else, thought this didn't really sound right because we had a lot of skepticism that [HCAHPS] surveys, [which] basically measured whether docs were nice to you, could somehow translate to better clinical outcomes."

Howard Kern, the president and CEO of Norfolk, Virginia-based Sentara Healthcare, which is not a Quantros customer, largely agrees.

Though he doesn't believe many patients will base their choice of where to have an important surgery or other treatment on the star ratings, he says the system's shortcomings muddy the waters for patients who want to choose among their healthcare options based on data and analysis.

Following, according to Kern and others, are three reasons the system needs big improvements.

1. Ratings are Oversimplified

The biggest challenge to the data is that CMS is trying to roll up a diversity of data metrics and reference points into a single rating, says Kern. "That's extraordinarily hard to do."

Even Consumer Reports, the evidence-based testing and rating organization, has a better system, he says.